young boy with budd chiari syndrome secondary heterozygous to factor V leiden - a case report

Budd Chiari syndrome [BCS] is a rare condition with exact incidence not known. It results from obstruction to the venous outflow of liver anywhere from the hepatic veins till the terminal inferior vena cava. Most cases are idiopathic; commonest cause being hypercoagulable state. Other causes include hepatic or metastatic malignancies, infections, inflammatory bowel disease, Behcet

syndrome, aspergillosis and rarely, Inferior vena cava webs. Clinical presentation of BCS is variable. Most of the patients present insidiously with abdominal pain, hepatomegaly and ascites. On rare occasions, onset can be in the form of lethal upper gastrointestinal bleeding due to ruptured esophageal varices

We report a case of BCS secondary to heterozygous factor V Leiden mutation in a young boy. Presentation in our patient was insidious, progressive ascites with abdominal pain

Frequency of acute bacterial meningitis in children presenting clinically as first simple febrile seizures under 6 years of age

Objective: To determine the frequency of acute bacterial meningitis in children [6 months to 6 years] presenting with first episode of simple febrile seizures

Study Design: A Cross sectional study

Place and Duration: Rawal Institute of Health Sciences Islamabad over a period of one and half year from 1st August 2013 to 31st January 2015

Methodology: One hundred and fifty patients of both genders aged from 6 months to 6 years were included who presented with fever and first episode of seizures but with no definite signs of meningitis. Sample of cerebrospinal fluid was sent to laboratory for cerebrospinal fluid [CSF] routine examination including cell count, protein and glucose content of CSF

Results: There were 103 males and 47 females with mean +/- SD of age 2.31 +/- 1.65 years. The mean +/- SD of protein, glucose and TLC were 53.89 +/- 51. Mg/dl, 69.27 +/- 22.51 mg/dl and 4.91 +/- 4.37/mm3 respectively. Among 150 children, 14 children had an acute bacterial meningitis

Conclusion: Meningitis have been documented in significant number of children with fever and seizures. Children less than six years of age is a major group at risk and Lumbar Puncture [LP] should be performed in every case of febrile seizures in this age group

Relation of pain and operative findings in acute gall bladder diseases

Objective: To observe whether duration of pain is a true reflector of operative findings in patients with acute gall bladder diseases

Study Design: Observational analytical

Place And Duration: Surgical Unit-ll, Pakistan Railway Hospital Rawalpindi spanning over a period of 02 years from May 2010 to may 2012

Methodology: 60 patients with acute gall bladder diseases were included through non probability convenience sampling. A proforma was designed to include clinical features, diagnostic work up, treatment plan and operative findings

Diagnostic work up included complete blood picture, liver function tests, hepatobiliary ultrasound. HIDAscan and CTscan was done if needed. Routine hematological and radiographic studies as indicated were performed

Results:: A total of 60 patients were studied and among them majority 83.3%[n=50] were females. In Patients with biliary colic group 41.7%[n=25], Murphy's sign was positive in 56%[n=14] and pathology on ultrasound scan was detected in 84%[n=21] of the patients. In patients with acute cholecystitis, fever 71.4%[n=25], Positive Murphy's sign 71.4%[n=25] and raised total leukocyte count 88.5%[n=31] were the commonest findings. Per operatively 68%[n=17] patients had chronically inflamed gall bladder and 16%[n=4] had acutely inflamed gall bladder among patients having symptoms of less than 12 hours duration. Acute inflammation of gall bladders commonly observed 65.7% [n=23], followed by chronically inflamed gall bladder 28.5%[n=10]

Conclusion: Duration of pain is a strong indicator of operative findings and thus patients outcome

Comparison of Topical Glyceryl Trinitrate and Nifedipine in Management of Chronic Anal Fissure

To compare the complete healing of chronic anal fissure by using 2% nifedipine paste and 0.5% glyceryl trinitrate ointment each applied locally for 6 weeks. Randomized Controlled Trail. Surgical Unit-I, Pakistan Railway Hospital Rawalpindi spanning over a period of 06 months starting from March 2011 to August 2011. Seventy six patients of chronic anal fissure were included in the study. Non-probability convenience sampling was used for the enrolment of patients. Patients were divided equally into two treatment groups A and B. Group [A] was treated with topical 2% nifedipine paste and Group [B] was treated with 0.5% glyceryl trinirate ointment. Patients were asked to come for the follow up after six weeks to look for symptomatic improvement and healing rate. All 38 patients included in the study completed the follow up after 06 weeks of treatment in either group. Three patients from Group B experienced intractable headache and were managed by analgesics accordingly but they went on to complete the treatment. None of the patient in group A had any significant side effect causing any adjustment in the treatment. At the end of 06 weeks of treatment, 28 patients in Group A and 25 in Group B showed complete healing of anal fissure. The overall healing rate was 69.75% [n=76]. There was statistically no significant difference at the end of 06 weeks of treatment [p=0.454]. It is concluded that 2% nifedipine paste is as effective as 0.5% GTN ointment in terms of healing of chronic anal fissure